Improving Transitions in Care for Patients and Family Caregivers Living in Rural and Underserved Areas: The Caregiver Advise, Record, Enable (CARE) Act

Griffin, Joan M.; Kaufman, Brystana G.; Bangerter, Lauren R.; Holland, Diane E.; Vanderboom, Catherine E.; Ingram, Cory; Wild, Ellen; Dose, Ann Marie; Stiles, Carole; Thompson, Virginia H.

doi:10.1080/08959420.2022.2029272

Cited by 14 publications

(6 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The benefits of the CARE Act may also motivate hospitals to rethink how they collaborate with caregivers and improve transitions of care for patients and their caregivers living in underserved communities. 26 For example, caregiver involvement could be formalized across other domains of delivery, including emergency department visits or end-of-life care. Furthermore, as hospitals and health care systems consider best practices to advance health equity and address social determinants of health, those that take a systematic approach to integrating caregivers might be better able to assess patients’ structurally determined risks and offset negative health outcomes associated with caregiving, which disproportionately affect individuals from minoritized racial and ethnic backgrounds.…”

Section: Discussionmentioning

confidence: 99%

Patient Experience at US Hospitals Following the Caregiver Advise, Record, Enable (CARE) Act

et al. 2023

View full text Add to dashboard Cite

ImportanceCommunication with caregivers is often not established or standardized during hospitalization. The Caregiver Advise, Record, Enable (CARE) Act is a state-level policy designed to facilitate communication among patients, caregivers, and clinical care teams during hospitalization to improve patient experience; 42 states have passed this policy since 2014, but whether it was associated with achieving these goals remains unknown.ObjectiveTo determine whether passage of the CARE Act was associated with improvements in patient experience.Design, Setting, and ParticipantsThis cohort study used a difference-in-differences analysis of short-term, acute-care US hospitals from 2013 to 2019 to analyze changes in patient experience before vs after CARE Act implementation in hospitals located in states that passed the CARE Act compared with those in states that did not. Analyses were performed between September 1, 2021, and July 31, 2022.ExposureTime-varying indicators for whether a hospital was in a state that passed the CARE Act.Main Outcomes and MeasuresPatient-reported experience via the Hospital Consumer Assessment of Healthcare Providers and Systems survey.ResultsA total of 2763 hospitals were included, with 2188 hospitals in CARE Act states and 575 in non–CARE Act states. There were differential improvements in patient experience in the measures of communication with nurses (unadjusted mean [SD] score, 78.40% [0.42%]; difference, 0.18 percentage points; 95% CI, 0.07-0.29 percentage points; P = .002), communication with physicians (mean [SD] score, 80.00% [0.19%]; difference, 0.17 percentage points; 95% CI, 0.06-0.28 percentage points; P = .002), and receipt of discharge information (mean [SD] score, 86.40% [0.22%]; difference, 0.11 percentage points; 95% CI, 0.02-0.21 percentage points; P = .02) among CARE Act states compared with non–CARE Act states after policy passage. In subgroup analyses, improvements were larger among hospitals with lower baseline Hospital Consumer Assessment of Healthcare Providers and Systems performance on measures of communication with nurses, communication with physicians, and overall hospital rating.Conclusions and RelevanceThese findings suggest that implementation of the CARE Act was associated with improvements in several measures of patient experience. Policies that formally incorporate caregivers into patient care during hospitalization may improve patient outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Patient Experience at US Hospitals Following the Caregiver Advise, Record, Enable (CARE) Act

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Although linked Medicare-Medicaid data illustrate the diverse patient experiences within the FBDE population, information on other services and supports that impact access to health care and quality of life are still not available. For example, documenting caregiver availability, opportunity costs, and use of respite care to relieve family members [19][20][21] is particularly relevant for dualeligible beneficiaries living with serious illness or disability. Additional patient-centered measures such as patient engagement, whole-person care, and out-of-pocket spending 22 could be measured by linking to additional sources such as Medical Expenditures Panel Survey and Medicare Beneficiary Survey.…”

Section: Discussionmentioning

confidence: 99%

Linking Medicare-Medicaid Claims for Patient-Centered Outcomes Research Among Dual-Eligible Beneficiaries

Jones,

Clark,

Greiner

et al. 2023

Medical Care

View full text Add to dashboard Cite

Background: Evaluation of Medicare-Medicaid integration models’ effects on patient-centered outcomes and costs requires multiple data sources and validated processes for linkage and reconciliation. Objective: To describe the opportunities and limitations of linking state-specific Medicaid and Centers for Medicare & Medicaid Services administrative claims data to measure patient-centered outcomes for North Carolina dual-eligible beneficiaries. Research Design: We developed systematic processes to (1) validate the beneficiary ID linkage using sex and date of birth in a beneficiary ID crosswalk, (2) verify dates of dual enrollment, and (3) reconcile Medicare-Medicaid claims data to support the development and use of patient-centered outcomes in linked data. Participants: North Carolina Medicaid beneficiaries with full Medicaid benefits and concurrent Medicare enrollment (FBDE) between 2014 and 2017. Measures: We identified need-based subgroups based on service use and eligibility program requirements. We calculated utilization and costs for Medicaid and Medicare, matched Medicaid claims to Medicare service categories where possible, and reported outcomes by the payer. Some services were covered only by Medicaid or Medicare, including Medicaid-only covered home and community-based services (HCBS). Results: Of 498,030 potential dual enrollees, we verified the linkage and FBDE eligibility of 425,664 (85.5%) beneficiaries, including 281,174 adults enrolled in Medicaid and Medicare fee-for-service. The most common need-based subgroups were intensive behavioral health service users (26.2%) and HCBS users (10.8%) for adults under age 65, and HCBS users (20.6%) and nursing home residents (12.4%) for adults age 65 and over. Medicaid funded 42% and 49% of spending for adults under 65 and adults 65 and older, respectively. Adults under 65 had greater behavioral health service utilization but less skilled nursing facility, HCBS, and home health utilization compared with adults 65 and older. Conclusions: Linkage of Medicare-Medicaid data improves understanding of patient-centered outcomes among FBDE by combining Medicare-funded acute and ambulatory services with Medicaid-funded HCBS. Using linked Medicare-Medicaid data illustrates the diverse patient experience within FBDE beneficiaries, which is key to informing patient-centered outcomes, developing and evaluating integrated Medicare and Medicaid programs, and promoting health equity.

show abstract

“…In hospitalized older adults chronic pain and depression are associated with prolonged length of stay and depression is also associated with increased risk of reinjury, poor clinical outcomes, and increased use of healthcare resources 16–20 . Informal caregivers are increasingly important in post‐acute care and transitions for older patients however caregiver strain is prevalent and associated with increased readmission for patients and adverse health outcomes and caregivers 21–23 . Informal caregivers are unpaid and comprise nearly nine in ten of all caregivers 24 .…”

Section: Introductionmentioning

confidence: 99%

“…[16][17][18][19][20] Informal caregivers are increasingly important in postacute care and transitions for older patients however caregiver strain is prevalent and associated with increased readmission for patients and adverse health outcomes and caregivers. [21][22][23] Informal caregivers are unpaid and comprise nearly nine in ten of all caregivers. 24 Previous studies have shown that integrating early palliative care interventions among older hospitalized patients can improve pain, depression, and caregiver strain; however, despite the high prevalence of trauma and opportunities for improvements in trauma care, these targets for palliative care have not been fully examined in seriously ill patients admitted with trauma.…”

Section: Introductionmentioning

confidence: 99%

The burden of pre‐admission pain, depression, and caregiving on palliative care needs for seriously ill trauma patients

Abbas

Reich

Wang

et al. 2023

J American Geriatrics Society

View full text Add to dashboard Cite

Introduction: Increasing numbers of individuals admitted to hospitals for trauma are older adults, many of whom also have underlying serious illnesses. Older adults with serious illness benefit from palliative care, but the palliative care needs of seriously ill older adults with trauma have not been elucidated.We hypothesize that older adults with serious illness have a high prevalence of pain, depression, and unpaid caregiving hours before trauma admission.Methods: Using Health and Retirement Study data (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018) linked to Medicare claims, we identified patients 66 years or older who met an established definition of serious illness in surgery and were admitted with trauma. Descriptive analyses were performed for baseline patient characteristics, preadmission pain (dichotomized as none/mild vs. moderate/severe), depression (dichotomized as no, Center for Epidemiologic Studies Depression scale [CES-D] < 3 vs. yes, CES-D ≥ 3), and unpaid caregiving hours (dichotomized as low (<30 h/month), high (≥30 h/month)). Results: We identified 1741 patients, 67.4% were female and 86.8% White.Mean age was 83 (SD 7.5), and 60.3% had ≥4 comorbidities. The majority (62.9%) were admitted due to falls, 33.5% had isolated hip fracture. The prevalence of baseline moderate/severe pain and depression were 38.1% and 42.6%, respectively. Among the cohort, 42.2% had unpaid caregiving, of those 27.7% had ≥30 h/week of unpaid caregiving hours.Conclusions: Prior to trauma admission, older adults with serious illness have a high prevalence of pain, depression, and unpaid caregiving hours. These findings may inform targeted palliative care interventions to reduce symptom burden and post-discharge healthcare utilization.

show abstract

Improving Transitions in Care for Patients and Family Caregivers Living in Rural and Underserved Areas: The Caregiver Advise, Record, Enable (CARE) Act

Cited by 14 publications

References 28 publications

Patient Experience at US Hospitals Following the Caregiver Advise, Record, Enable (CARE) Act

Patient Experience at US Hospitals Following the Caregiver Advise, Record, Enable (CARE) Act

Linking Medicare-Medicaid Claims for Patient-Centered Outcomes Research Among Dual-Eligible Beneficiaries

The burden of pre‐admission pain, depression, and caregiving on palliative care needs for seriously ill trauma patients

Contact Info

Product

Resources

About